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Aims & Objectives: The purpose of this study was to identify patient characteristics associated with engagement and completion of physical therapy (PT) following total knee arthroplasty (TKA) and examine the relationship between number of PT sessions attended and outcomes during the first 12 weeks after surgery. Methods: Patients underwent unilateral primary TKA by a single surgeon and were advised to complete 17 PT sessions over 6 weeks at a hospital-affiliated facility. Analyses examined predictors of PT engagement (attendance of ≥2 sessions) and completion (attendance of 17 ± 1 sessions) within 6 weeks and associations between number of PT sessions attended and changes in range of motion (ROM) and Knee Injury and Osteoarthritis Outcome Score (KOOS) values. Results: Patients living <40 km were more likely to be engaged in PT than those living ≥40 km from the clinic (P <.0001). Among patients who completed PT within 6 weeks, 95.0%, 85.1%, and 56.4% achieved flexion of, respectively, ≥90°, ≥100°, and ≥110°. Among engaged patients, the active flexion thresholds of ≥90°, ≥100°, and ≥110° were achieved by, respectively, 94.4%, 82.5%, and 58.1% by 6 weeks and by 96.7%, 92.1%, and 84.2% by 12 weeks. Improvement in KOOS Symptoms (P =.029), Function in daily living (P =.030) and quality of life (P =.031) linearly decreased as number of PT sessions increased. Conclusions: These results raise the question of whether patients who meet satisfactory outcomes before completing 6 weeks of prescribed PT and those who attend more PT sessions than prescribed may be over-utilizing healthcare resources without additional benefit. [ABSTRACT FROM AUTHOR]

Research has been conducted on adherence to antiretroviral therapy associated with AIDS progression, viral load suppression and death in HIV-infected persons. The use of computer-assisted self-interviewing technology in identifying errors in HIV antiretroviral regimen and in monitoring adherence in order to maximize antiretroviral therapy benefits is discussed.

Even though current domestic violence guidelines, such as those published by the AMA in 1992, attempt to relieve physicians of the 'full burden of intervention,' they continue to call upon physicians to play a large role in identifying, intervening in, and following up on case of partner abuse. In this paper, we define a limited domestic violence role for physicians which furthers the direction recommended by the AMA and which complements exemplary programs. We propose simplifying and limiting physicians' tasks to Asking patients about abuse; providing Validating messages, acknowledging that battering is wrong and confirming patient worth; Documenting presenting signs, symptoms, and disclosures; and Referring victims to domestic violence specialists (AVDR). By drawing on the literature and our own experience, we show how focusing the physician's role on these four taks is consistent with exemplary programs and expands on ideas put forth by experts for addressing domestic violence in health care settings; reduces barriers for physician interventions with victims; offers a realistic approach for physicians, reducing unrealistic educational demands; and complements managed care trends in contemporary health care. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: Website: KEYWORDS. Domestic violence, simplified physicians' role, interventions, domestic violence guidelines

Many dentists might be able to identify domestic abuse in their patients if they receive domestic violence education. In a survey of 321 dentists, 87% said they never screened for domestic violence. The most common barriers were the presence of a partner or children, lack of training, or embarrassment.

This qualitative study aimed to describe, from the perspective of domestic violence survivors, what helped victims in health care encounters improve their situation and thus their health, and how disclosure to and identification by health care providers were related to these helpful experiences. Semi-structured, open-ended interviews were conducted with a purposeful sample of survivors in the San Francisco Bay Area. Data were analyzed using constant comparative techniques and interpretative processes. Twenty-five women were interviewed, the majority being white and middle-class, with some college education. Two overlapping phenomena related to helpful experiences emerged: (1) the complicated dance of disclosure by victims and identification by health care providers, and (2) the power of receiving validation (acknowledgment of abuse and confirmation of patient worth) from a health care provider. The women described a range of disclosure and identification behaviors from direct to indirect or tacit. They also described how-with or without direct identification or disclosure-validation provided 'relief,' 'comfort,' 'planted a seed,' and 'started the wheels turning' toward changing the way they perceived their situations, and moving them toward safety. Our data suggest that if health care providers suspect domestic violence, they should not depend on direct disclosure, but rather assume that the patient is being battered, acknowledge that battering is wrong, and confirm the patient's worth. Participants described how successful validation may take on tacit forms that do not jeopardize patient safety. After validating the patient's situation and worth, we suggest health care providers document the abuse and plan with the patient for safety, while offering ongoing validation, support, and referrals. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com] KEYWORDS. Domestic violence, qualitative, health care provider, disclosure, abuse